MEDICARE: SHARON GOODMAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	F381513	NY

General Provider Information

NPI Number	:	1932194305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON GOODMAN NP

Provider Business Mailing Address
First Line	:	410 LAKEVILLE RD STE 105
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1102
Country	:	US
Telephone Number	:	516-465-5255
Fax Number	:	718-347-2240

Provider Business Practice Location Address
First Line	:	410 LAKEVILLE RD STE 105
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1102
Country	:	US
Telephone Number	:	516-465-5255
Fax Number	:	718-347-2240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/09/2012

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